Respiratory 28 Allergen Panel

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Respiratory 28 Allergen Panel
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

RSPP

Test Workstation :

MAYO

Specimen Type:

Blood

Tube Type:

Red top ( no anticoagulant) tube

Collection Volume:

9.0 mL

Minimum Volume:

7.5 mL

Storage:

Refrigerated

Availability:

Sent to Mayo Medical Laboratory

Methodology:

Fluorescence Enzyne Immunoassay ( FEIA)

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range is available on patient report

CPT Code:

86003

Panel Includes:

Cat Epithelium IgE, Short Ragweed IgE, Mountain Cedar IgE, Elm IgE, Oak IgE, Silver Birch IgE, Russian Thistle IgE, Cockroach IgE, Rough Marsh Elder IgE, White Hickory IgE, Easter Sycamore IgE, Rough Pigweed IgE, White Ash IgE, Walnut IgE, Nettle IgE, Red Sorrel IgE, Cottonwood IgE, Mulberry IgE, Boxelder-Maple IgE, Timothy Grass IgE, Bermuda Grass igE, House Dust Mites/D.P. IgE, House Dust Mites/D.F. IgE, Alternaria Tenuis IgE, Aspergillus Fumigatus IgE, Cladosporium IgE, Penicillium IgE, Dog Dander IgE

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Respiratory 28 Allergen Panel

Centralized Core Laboratory - Mayo Clinic Laboratories : Send Out

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